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Bone Marrow Transplant: Symptoms, Classification, Diagnosis & Recovery

A bone marrow transplant is a process that involves harvesting cells for transplantation from the bone marrow which is the spongy tissue found in the cavities of certain bones such as the hip bones. It is also known as Stem Cell transplant. The bone marrow is rich in stem cells, which are capable of developing into various types of blood cells.

The main objective of bone marrow transplantation (BMT) is to transplant healthy bone marrow cells into a patient after the patient's unhealthy bone marrow has been treated to eliminate cancerous cells.

BMT has been used successfully in the treatment of the following diseases such as:

  1. Aplastic anemia
  2. Immune deficiency disorders
  3. Adrenoleukodystrophy
  4. Bone marrow failure syndromes
  5. Chronic leukemia
  6. Hemoglobinopathies
  7. Hodgkin's lymphoma
  8. Inborn errors of metabolism
  9. Multiple myeloma
  10. Myelodysplastic syndromes
  11. Neuroblastoma
  12. Non-Hodgkin's lymphoma
  13. Plasma cell disorders
  14. POEMS syndrome
  15. Primary amyloidosis

There are two main types of bone marrow transplants (BMT), also known as stem cell transplants, based on the source of the stem cells. These are:

  • Autologous Transplant (AutoBMT): In an autologous transplant, the patient's stem cells are used for the transplant. Before the transplant, the patient's stem cells are collected, usually from the blood, and freeze. After high-dose chemotherapy or radiation treatment to eliminate diseased cells, the stored frozen stem cells are infused back into the patient. This type of transplant is often used in conditions like multiple myeloma or lymphoma.
  • Allogeneic Transplant (AlloBMT): In an allogeneic transplant, the stem cells come from a donor, typically a sibling or unrelated matched donor. Allogeneic transplants are more complex and carry a higher risk of complications, but they can offer a potentially curative treatment for diseases like leukemia, aplastic anemia, or certain genetic disorders.

During the Bone marrow Transplant, the signs and symptoms depend upon the age and overall health of the patient and the nature of the donor. The following are the symptoms:

  • Chest pain
  • Drop in blood pressure
  • Fever, chills, flushing
  • Headache
  • Hives
  • Nausea
  • Pain
  • Shortness of breath
  • Strange taste in the mouth

Diagnostic tests play a crucial role in evaluating a patient's eligibility for a bone marrow transplant (BMT) and monitoring their health throughout the process. Some key diagnostic tests used in the context of bone marrow transplant include:

  • Blood Tests: Routine blood tests assess blood cell counts and function, which can indicate the need for a transplant and track the patient's response to treatment.
  • Bone Marrow Aspiration and Biopsy: These tests involve the extraction of a small sample of bone marrow and a piece of bone to assess the health of the bone marrow, identify abnormalities, and determine the presence of cancer cells.
  • Hematopoietic Stem Cell (HSC) Collection: Tests are conducted to assess the ability to collect an adequate number of hematopoietic stem cells for transplantation, whether from the patient (autologous) or a donor (allogeneic).
  • Tissue Typing (HLA Typing): For allogeneic transplants, tissue typing is performed to match the human leukocyte antigens (HLA) between the donor and recipient, reducing the risk of graft-versus-host disease (GVHD).
  • Cytogenetic Analysis: It examines the chromosomal structure of cells, helping to identify genetic abnormalities and assess the risk of disease recurrence.
  • Immunological Tests: Tests may be conducted to evaluate the immune system's function and its ability to tolerate or reject the transplanted cells.
  • Viral and Infectious Disease Screening: Patients and donors undergo screening for viruses (such as HIV, and hepatitis) and other infectious diseases to ensure a safe transplant process.

To ensure the patient is ready for a stem cell transplant, a series of tests will assess the overall health and condition, and A suitable donor identified for allogeneic transplants. This can be a sibling, an unrelated donor, or, in some cases, a half-matched family member (haploidentical).

This test may take a few days, a thin tube, known as a central line, is placed in a large vein in the chest or neck. This central line stays in place throughout the treatment, allowing the transplant team to deliver stem cells, medications, and blood products. This is called conditional therapy.

Following the completion of all pre-surgery testing, the following goals would be attained by performing Ablation therapy by the oncologists through chemotherapy and radiation to

  • Destruct the cancer cells
  • Suppress the immune system
  • Prepare the bone marrow for receipt of new stem cells

Collection of the stem cells: For autologous transplants, the patient's stem cells are collected. This is usually done through a process called apheresis, where blood is drawn, stem cells are separated, and the remaining blood is returned to the patient.

For allogeneic transplants, the donor undergoes a similar process to collect stem cells.

Transplantation: The harvested stem cells are infused into the patient through a central venous catheter, similar to a blood transfusion. The infused stem cells travel to the bone marrow, where they begin to produce new blood cells.

Following the transplant, supportive care is provided to prevent and treat infections, side effects of treatments, and complications. This includes frequent blood tests, close monitoring of vital signs, strict measurement of fluid input and output, daily weigh-ins, and providing a safe and clean environment.

Engraftment: Engraftment refers to the successful establishment of the transplanted cells in the patient's bone marrow. This is monitored by regular blood tests to check for the presence of donor cells.

While undergoing bone marrow infusions, the patient could feel Pain, Chills, Fever, and Chest Pain.

Following a stem cell transplantation until the bone marrow can sufficiently produce blood cells, patients are at an increased risk of infections and diseases. To prevent contamination, individuals undergoing stem cell transplantation are typically placed in isolation rooms. This precautionary measure lasts for over a week or until the blood cell levels return to normal.

Isolation is more important in the case of allogeneic stem cell transplant than autologous stem cell transplant. This is the reason why some hospitals do not prefer to keep a patient who has had an autologous transplant isolated.

During the recovery phase, only one or two visitors are permitted, and those already unwell are strongly discouraged from visiting. Some hospitals offer autologous stem cell transplants on an outpatient basis, although regular follow-up visits for health monitoring are essential for a month or longer. The protective measures aim to ensure a safe and steady recuperation for patients during this critical phase of their treatment.

Marsha Akatu, Bone marrow transplant
Marsha Akatu

Kenya

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Bushra Masoud

Oman

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Frequently Asked Questions

Q. Is an autologous transplant safer than an allogeneic transplant?

A. By thumb rule, using stem cells from one’s body is better any day. However, a potential risk of side effects is associated with both types of stem cell transplant.

Q. What is the average length of stay for a bone marrow transplant?

A. The average length of stay for stem cell transplant may vary between one to two weeks, depending on the recovery of the patient. In some cases, the hospitalization stay is less than one week.